News Release

Methadone maintenance found to be more effective in treating heroin addiction than 180 day detoxification program, UCSF study reports

Peer-Reviewed Publication

University of California - San Francisco

Methadone maintenance is more effective in reducing heroin use among addicts than a 180 -day detoxification program that included an array of counseling services, a UC San Francisco study has found.

The objective of the study was to compare methadone maintenance-a widely used but controversial method of weaning heroin addicts off the drug-- with an alternative treatment of psychosocially enriched 180 day methadone assisted detoxification. Methadone maintenance resulted in lower heroin use rates and fewer drug- related HIV risk behaviors, such as sharing needles. The study results will be published in the March 8 issue of the Journal of the American Medical Association.

"Methadone maintenance is controversial," said Sharon Hall, PhD, lead author of the study and UCSF professor in residence and vice-chair of psychiatry. "People don't like it because it is continued provision of an addicting drug. When people come on methadone maintenance, they may stay on it for several years. The idea of the study was to do a comparison to find a method that was as effective but didn't involve indefinite treatment with an addicting drug."

Methadone maintenance has been used to treat heroin addiction since 1964, Hall said. Heroin is a short- acting opiate, Hall explained, meaning it produces a high and a withdrawal effect rapidly. Methadone is a slower acting--and legal--opiate. It works by stabilizing heroin users so that they do not have a heroin -induced euphoria or suffer from severe withdrawal symptoms.

The study enrolled 179 participants who were assessed monthly for a year. A urine specimen was collected each time.

Those in the methadone maintenance part of the study received stable doses of methadone. Participants also attended one hour per week of substance abuse group therapy for the first six months and one hour per month of individual therapy.

Those in the 180 -day detoxification program received 120 days of methadone treatment, followed by 60 days of methadone dose reduction until they were no longer taking methadone. They also received a host of drug counseling services. During the first six months, participants were required to attend two hours per week of substance abuse group therapy, one hour per week of cocaine group therapy if they were found to also be addicted to that drug, and a series of one- hour substance abuse education classes held weekly. They also attended weekly individual therapy sessions. During the last seven months of the study, participants were offered aftercare treatment that included weekly individual and group psychotherapy and liaison services with the criminal justice system, medical clinics and social service agencies.

Methadone maintenance was found to retain more patients and be more effective in decreasing heroin use, though use was still high in both groups. Also, the study found that those addicted to cocaine were more likely to drop out of the 180-day program than the methadone maintenance program.

"I think the results came out the way they did because heroin is a very addicting drug and we need pharmacological tools at this point to fight that addiction," Hall said. "It's not enough to just provide psychosocial services when we lose methadone. There are two ways the field could change. One is to develop more sophisticated pharmacological treatments for heroin addiction that have less addiction potential. Another thing we need to think about is developing psychosocial interventions targeting what methadone patients need like legal and vocational services."

Hall added that one of the reasons the counseling services offered as part of the 180- day detoxification program did not lower heroin use might be because they were too general.

"The other thing this study points out is that a long time ago methadone maintenance clinics had many more services than they do now," she said. "And perhaps that's one of the reasons the 180 day detoxification didn't work. The services were limited in scope. We didn't have legal or vocational services or family therapy. Many methadone programs have lost funding for these types of services and we have yet to see what a methadone program looks like that has them."

A National Institute on Drug Abuse grant funded this study.

Other authors of the study are: Karen Sees, DO, UCSF assistant clinical professor of psychiatry; Kevin Delucchi, PhD, UCSF assistant professor of psychiatry; Carmen Masson, PhD, UCSF adjunct professor of psychiatry; Amy Rosen, PsyD, UCSF research coordinator; H. Westley Clark, MD, MPH, on leave from position as UCSF associate clinical professor of psychiatry; Helen Robillard, RN, MSN, MA, research nurse practitioner at the Veteran Affairs Medical Center in San Francisco; Peter Banys, MD, associate clinical professor and vice chair, psychiatry at the Veteran Affairs Medical Center in San Francisco.

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